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Ali S, Tallent J, Sambrook H, MacInnes D, Kinane C. Effectiveness of psychological interventions for carers of patients with severe mental illness (SMI): a systematic review. BMJ Open 2024; 14:e086149. [PMID: 39438102 PMCID: PMC11499822 DOI: 10.1136/bmjopen-2024-086149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 10/04/2024] [Indexed: 10/25/2024] Open
Abstract
OBJECTIVES Interventions for carers of patients with severe mental illness (SMI) are effective in improving patient outcomes. This review examined the effectiveness of psychological interventions or support designed to help carers of patients with SMI. DESIGN A systematic review of randomised controlled trials (RCTs) was conducted. Study selection, data abstraction and risk of bias assessments were independently conducted and duplicated. The reporting of this review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. DATA SOURCES CINAHL, CENTRAL, EMBASE, Medline and PsycINFO were searched from inception to 30 April 2024. ELIGIBILITY CRITERIA Only studies using an RCT were considered. All other research designs were excluded. The included population was carers over 18 caring for a patient with SMI. Any psychological, psychosocial or psychoeducational interventions were included. Patients under 18, diagnosed with dementia or learning disabilities comorbidity, were excluded. DATA EXTRACTION AND SYNTHESIS Study characteristics and outcome data (mean and SD) for each included study were collected. Review Manager (RevMan) was used to manage the data. Meta-analysis was not considered appropriate due to the heterogeneity of the included studies. The results were presented as a narrative synthesis. RESULTS This review included 3869 participants from 32 RCTs and demonstrated a beneficial effect of psychological interventions for carers. Psychoeducation was widely used and the most evaluated intervention for carers. CONCLUSIONS Psychological interventions for carers are beneficial in helping to reduce negative outcomes and enhance positive outcomes. Future research could focus on exploring the impact of interventions on less evaluated outcomes such as depressive and anxiety symptoms. PROSPERO REGISTRATION NUMBER CRD42021233181.
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Affiliation(s)
- Syed Ali
- Forensic Healthcare Service, Sussex Partnership NHS Foundation Trust, Hailsham, East Sussex, UK
| | - Jacqueline Tallent
- Sidney De Haan Research Centre for Arts and Health, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Harry Sambrook
- Psychology and Psychological Therapies (PPT) Forensic Healthcare, Sussex Partnership NHS Foundation Trust, Hailsham, East Sussex, UK
| | - Douglas MacInnes
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Catherine Kinane
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, UK
- Combat Stress, Leatherhead, Surrey, UK
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Stokholm JR, Vinberg M, Faurholt-Jepsen M, Kessing LV. Study protocol: group-based psychoeducation for relatives of patients with bipolar disorder-a large scale real-world randomized controlled parallel group trial, the R-bipolar RCT. Trials 2024; 25:342. [PMID: 38783322 PMCID: PMC11119791 DOI: 10.1186/s13063-024-08172-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Relatives of patients with bipolar disorder (BD) often experience emotional burden with stress and depressive symptoms that again increase the likelihood of destabilization and relapses in the patient. The effects of group-based psychoeducation have not been investigated in large-scale real-world settings. We are currently conducting a large-scale real-world randomized controlled parallel group trial (RCT) to test whether group-based psychoeducation for 200 relatives to patients with BD improves mood instability and other critical outcomes in relatives and the corresponding patients with BD. METHODS The trial is designed as a two-arm, parallel-group randomized trial with a balanced randomization 1:1 to either group-based psychoeducation or a waiting list for approximately 4 months and subsequent group-based psychoeducation. The primary outcome measure is mood instability calculated based on daily smartphone-based mood self-assessments. Other relevant outcomes are measured, including patients' reported outcomes, assessing self-assessed burden, self-efficacy, and knowledge about BD. DISCUSSION This protocol describes our currently ongoing randomized controlled trial (RCT) that aims at investigating group-based psychoeducation as an intervention for relatives of individuals diagnosed with bipolar disorder (BD). The study is the first large-scale real-world RCT to focus on a relatively short intervention of psychoeducation (6 sessions of 2 h each) in a large group of relatives (approximately 30 participants per group). With this focus, we wish to test an intervention that is feasible to implement in real-life psychiatric settings with limited budgets and time. It is also the first study to use mood instability in relatives as the primary outcome measure and to investigate whether mood instability and other affective symptoms in patients and relatives covary. It could be considered as limitations, that the trial is not blinded and does not include long-term follow-up. TRIAL REGISTRATION ClinicalTrials.gov NCT06176001. Registered on 2023-12-19. The study is approved by the data agency (P-2021-809). The project was allowed to be initiated without permission from the Scientific Ethical Committees for the Capital Region, because it according to section 1, paragraph 4 of the Committee Act was not defined as a health scientific intervention study (case number 21063013).
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Affiliation(s)
- Julie Ravneberg Stokholm
- Psychiatric Center Copenhagen, The Copenhagen Affective Disorder Research Center (CADIC), Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre Northern Zealand, Hillerød, Denmark
| | - Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, The Copenhagen Affective Disorder Research Center (CADIC), Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, The Copenhagen Affective Disorder Research Center (CADIC), Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Abu Sabra MA, Hani SB, Jebbeh RA. The Assessment of Awareness of Early Warning Signs of Bipolar Disorder Recurrence Among Patients and Their Main Caregivers in Jordan. SAGE Open Nurs 2024; 10:23779608241299271. [PMID: 39544995 PMCID: PMC11561989 DOI: 10.1177/23779608241299271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 09/12/2024] [Accepted: 10/26/2024] [Indexed: 11/17/2024] Open
Abstract
Introduction One of the biggest challenges to public health is increasing knowledge of the early warning signs (EWS) of bipolar disorder recurrence. The recurrence incidence is still high despite multiple attempts to improve the awareness level. The awareness level is still ambiguous and insufficient. Objective The purpose of this study was to assess the degree of awareness of EWS of bipolar disorder recurrence among patients and their main caregivers in Jordan. Methods A descriptive cross-sectional design was used to recruit 275 patients and their main caregivers to fill out the adapted version of the Awareness of the EWS of Relapse Questionnaire. Results The analysis showed that patients and their main caregivers' awareness of the EWS of bipolar disorder recurrence was low and inadequate (patients, mean = 2.61 (SD = 2.6); main caregivers, mean = 3.84 (SD = 2.2); scores range from 0 to 10). Conclusion According to the study, the awareness level of these signs is still vague and inadequate. This means that ensuring long-term positive results for patients and their main caregivers requires a high degree of awareness regarding the warning signs and symptoms of bipolar disorder recurrence. To engage in standard practice, EWS of bipolar disorder recurrence awareness necessitate adequate resources, support, and an empowered and well-communicated multidisciplinary team.
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Affiliation(s)
| | | | - Raid Abu Jebbeh
- School of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
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Sampogna G, Brohan E, Luciano M, Chowdhary N, Fiorillo A. Psychosocial interventions for carers of people with severe mental and substance use disorders: a systematic review and meta-analysis. Eur Psychiatry 2023; 66:e98. [PMID: 37997647 PMCID: PMC10755580 DOI: 10.1192/j.eurpsy.2023.2472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Severe mental disorders - such as schizophrenia, bipolar disorder, and substance use disorders - exert a negative impact not only on affected people but also on their carers. To support carers of people with severe mental disorders, several psychosocial interventions have been developed. METHODS This systematic review and meta-analysis aimed to assess whether psychosocial interventions for carers of persons with schizophrenia, bipolar disorder, or substance use disorders produce benefit/harm with respect to a series of outcomes - including subjective and objective burden, depressive symptoms, well-being/quality of life, sleep, skills/knowledge, self-efficacy, physical health - as compared to standard support/support as usual or other control conditions. RESULTS In carers of persons with schizophrenia, psychoeducational interventions were associated with significant improvement in personal burden, well-being, and knowledge about the illness; and a supportive-educational intervention with an improvement in personal burden. In carers of persons with bipolar disorder, psychoeducational interventions were associated with significant improvement in personal burden and depressive symptoms; family-led supportive interventions with an improvement in family burden; family-focused intervention and online "mi.spot" intervention with a significant reduction in depressive symptoms. Psychosocial interventions used for carers of persons with substance use disorders were found to be overall effective on the level of well-being, but the low number of trials did not allow detection of differences between the various psychosocial interventions. CONCLUSIONS The quality of the evidence ranged from very low to moderate, suggesting the need for further better-quality research.
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Affiliation(s)
- Gaia Sampogna
- Department of Mental Health, University of Campania “L. Vanvitelli”, Naples, Italy
- WHO Collaborating Centre for Research and Training, Naples, Italy
| | - Elaine Brohan
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mario Luciano
- Department of Mental Health, University of Campania “L. Vanvitelli”, Naples, Italy
- WHO Collaborating Centre for Research and Training, Naples, Italy
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Andrea Fiorillo
- Department of Mental Health, University of Campania “L. Vanvitelli”, Naples, Italy
- WHO Collaborating Centre for Research and Training, Naples, Italy
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Reed M, Bedard C, Perlman CM, Browne DT, Ferro MA. Family Functioning and Health-Related Quality of Life in Parents of Children with Mental Illness. JOURNAL OF CHILD AND FAMILY STUDIES 2023:1-12. [PMID: 37362627 PMCID: PMC9958324 DOI: 10.1007/s10826-023-02556-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 06/28/2023]
Abstract
Previous research suggests that family dysfunction may be related to lower health-related quality of life (HRQoL) in parent caregivers, but it is unknown if this association exists in the context of child mental illness. Therefore, the objectives of this study were to compare HRQoL between parent caregivers and Canadian population norms using the Short Form 36 Health Survey (SF-36); examine associations between family functioning and parental HRQoL; and investigate whether child and parental factors moderate associations between family functioning and parental HRQoL. Cross-sectional data were collected from children receiving mental healthcare at a pediatric hospital and their parents (n = 97). Sample mean SF-36 scores were compared to Canadian population norms using t-tests and effect sizes were calculated. Multiple regression was used to evaluate associations between family functioning and parental physical and mental HRQoL, adjusting for sociodemographic and clinical covariates. Proposed moderators, including child age, sex, and externalizing disorder, and parental psychological distress, were tested as product-term interactions. Parents had significantly lower physical and mental HRQoL versus Canadian norms in most domains of the SF-36, and in the physical and mental component summary scores. Family functioning was not associated with parental physical HRQoL. However, lower family functioning predicted lower parental mental HRQoL. Tested variables did not moderate associations between family functioning and parental HRQoL. These findings support the uptake of approaches that strive for collaboration among healthcare providers, children, and their families (i.e., family-centered care) in child psychiatry settings. Future research should explore possible mediators and moderators of these associations.
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Affiliation(s)
- Madeline Reed
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON Canada
| | - Chloe Bedard
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON Canada
| | - Christopher M. Perlman
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON Canada
| | - Dillon T. Browne
- Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON Canada
| | - Mark A. Ferro
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON Canada
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Speirs B, Hanstock TL, Kay-Lambkin FJ. The lived experience of caring for someone with bipolar disorder: A qualitative study. PLoS One 2023; 18:e0280059. [PMID: 36656805 PMCID: PMC9851531 DOI: 10.1371/journal.pone.0280059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 12/20/2022] [Indexed: 01/20/2023] Open
Abstract
Being a close family or friend of someone with bipolar disorder (BD) can lead to experiences of increased stress, anxiety and depressive symptoms related to the burden of caring. However, the lived experience of being a carer for a person with BD has not received significant research attention. This study aimed to gain further insight into the experiences of individuals in an informal caring role for someone with BD and determine what additional information and support these people need to take care of both themselves and the person they are caring for. Fifteen qualitative interviews were carried out with carers discussing their lived experiences with utilising coping strategies and supporting someone with BD. Following the interviews, thematic analysis was used to identify five key themes. These themes were: Separation of the person and the disorder, carer health and coping strategies, unpredictability and variability of symptoms, carer disillusionment and silencing, and story sharing and support needs. Overall, the findings highlighted the need for increased in-person and online support specifically tailored for carers with loved ones experiencing BD.
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Affiliation(s)
- Bronte Speirs
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Tanya L. Hanstock
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Frances J. Kay-Lambkin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
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Fitzgeraldson E, Triandafilidis Z, Franklin Y, Palazzi K, Kay-Lambkin F, Fitzpatrick S. Feasibility and Acceptability of a Novel Online Program for Mental Health Carers. Int J Psychol Res (Medellin) 2023; 16:41-55. [PMID: 37547866 PMCID: PMC10402641 DOI: 10.21500/20112084.5733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/11/2022] [Accepted: 09/21/2022] [Indexed: 08/08/2023] Open
Abstract
Objective To evaluate the feasibility and acceptability of a new online program (Minds Together ) for carers of a person with depressive or anxiety symptoms. Methods Using a two-arm randomised controlled trial design, 108 carers of a person with depressive or anxiety symptomology aged 16 years or over (89% female; mean age 50 years) received immediate or delayed access to the Minds Together program. Feasibility was measured using program activation and survey completion rates. Acceptability was measured using a project-specific satisfaction scale, semi-structured interviews, and program completion metadata. The study used intention-to-treat (ITT) analysis for participant-reported outcomes (carer burden, coping self-efficacy) across groups. Results Feasibility and acceptability thresholds were consistent with similar studies: 59% activated their program account, 47% met the program completion threshold, and almost all reported satisfaction with the program. The ITT indicated trends in increased coping self-efficacy and reduced carer burden for the Intervention group, compared to the Waitlist control. Conclusions The Minds Together program is a feasible and acceptable program for carers supporting a person with depressive or anxiety symptomology. Results support exploration of the program's efficacy in a full-scale RCT.
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Affiliation(s)
- E Fitzgeraldson
- Everymind, Newcastle, Australia. University of Newcastle, Newcastle, Australia. University of NewcastleUniversity of NewcastleAustralia
| | - Z Triandafilidis
- School of Medicine and Public, University of Newcastle, Newcastle, Australia. University of NewcastleUniversity of NewcastleAustralia
| | - Y Franklin
- Everymind, Newcastle, Australia. Australia
| | - K Palazzi
- Everymind, Newcastle, Australia. Australia
| | - F Kay-Lambkin
- Hunter Medical Research Institute, New Lambton Heights, Australia. Hunter Medical Research InstituteAustralia
| | - S Fitzpatrick
- University of Newcastle, Newcastle, Australia. University of NewcastleUniversity of NewcastleAustralia
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Fitzgeraldson E, Kay-Lambkin F, Harding N, McNaughton KM, Triandafilidis Z, Heath J, Lyford B, Charnley J, Fitzpatrick S. Supports and Interventions for Carers of a Person with Depressive or Anxiety Symptomology: A Systematic Review. EUROPES JOURNAL OF PSYCHOLOGY 2022; 18:476-493. [PMID: 36605087 PMCID: PMC9780730 DOI: 10.5964/ejop.6407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/03/2021] [Indexed: 12/05/2022]
Abstract
An increasing body of research attests to the capacity of evidence-based interventions to improve outcomes for informal carers. A review of suitable supports and interventions for carers of a person with depressive or anxiety symptomology is timely. This systematic review explores intervention suitability evidence for this carer group. Searches for relevant primary studies were conducted in six databases across a 15-year timeframe (October 2004-October 2019). Studies were assessed and compared narratively and thematically. Qualitative themes were synthesised with quantitative studies to explore the extent to which carer preferences were embedded in interventions. The initial literature search produced 13,183 studies. Six studies-three randomised controlled trials (RCTs) and three mixed-method studies-were included following a double-blinded screening process, a review of reference lists and risk of bias assessment. Included studies contributed either intervention efficacy or acceptability evidence. The synthesis of qualitative themes with quantitative studies found that carer-specific needs and targeted psychoeducation were featured in interventions from all six quantitative studies. Current evidence for appropriate supports and interventions for this carer group is limited. The review uncovers a lack of interventions for carers of a person with anxiety symptomology and limited intervention suitability evidence for carers of a person with depressive symptomology. More research is needed to explore the needs and preferences of this carer group, and how best to support them.
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Affiliation(s)
| | - Frances Kay-Lambkin
- University of Newcastle, Newcastle, Australia
- NHMRC Centre for Research Excellence in Mental Health & Substance Abuse, Macquarie University, Sydney, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- Centre for Brain and Mental Health Priority Research Centre, University of Newcastle, Newcastle, Australia
- Society for Mental Health Research, Victoria, Australia
- International Society for Research on Internet Interventions, Sanford, NC, USA
| | - Natasha Harding
- University of Newcastle, Newcastle, Australia
- Everymind, Newcastle, Australia
| | - Kimie M. McNaughton
- University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- Centre for Brain and Mental Health Priority Research Centre, University of Newcastle, Newcastle, Australia
| | - Zoi Triandafilidis
- University of Newcastle, Newcastle, Australia
- Centre for Brain and Mental Health Priority Research Centre, University of Newcastle, Newcastle, Australia
| | - Jacinta Heath
- Child and Adolescent Mental Health Service, Hunter New England Health, Sydney, Australia
| | - Bronte Lyford
- University of Newcastle, Newcastle, Australia
- Everymind, Newcastle, Australia
| | - Janine Charnley
- University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- Centre for Brain and Mental Health Priority Research Centre, University of Newcastle, Newcastle, Australia
- Society for Mental Health Research, Victoria, Australia
| | - Sally Fitzpatrick
- University of Newcastle, Newcastle, Australia
- Everymind, Newcastle, Australia
- Centre for Emotional Health, Macquarie University, Sydney, Australia
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Getting back on track: a group psychoeducational intervention for patients and families living with head and neck cancer. Support Care Cancer 2022; 30:3259-3268. [PMID: 34984551 DOI: 10.1007/s00520-021-06771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Head and neck cancer survivors are increasing in prevalence, and 60-70% still experience at least one unmet emotional and/or physical need after treatment has ended. The purpose of this study was to determine the efficacy of a brief post-treatment psychoeducational intervention on perceived preparedness for coping with recovery using post-session evaluations. METHODS Between August 2013 and May 2018, a two-session, multidisciplinary "getting back on track" class was delivered to head and neck cancer patients approximately 2 months following radiation treatment at Princess Margaret Cancer Centre in Toronto, Canada. Three hundred and fifty attendees completed evaluations. Statistical analyses of the 310 patients surveyed measured change in level of preparedness to cope with recovery using the b-prepared scale. Qualitative analyses provided insight into potential benefits for future patients. RESULTS Almost two-thirds (58%) of patients reported an increase in level of preparedness in post-intervention surveys. Comparing self-reported level of preparedness among patients from before to after the class showed an increase in feeling prepared from 50 to 58%, and of those feeling very prepared, from 6 to 34%. The proportion of patients who reported feeling unprepared (11%) or neutral (33%) before the class decreased post-intervention, with 0% feeling unprepared and 7% feeling neutral. There were statistically significant differences in the ideal timing of the class, but overall attendees agreed that the class is an essential part of their recovery. CONCLUSION Results confirm the efficacy of this brief psychoeducational intervention to improve preparedness in head and neck cancer survivors following radiation treatment.
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Psychoeducational groups for close relatives of patients with borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01395-8. [PMID: 35294615 DOI: 10.1007/s00406-022-01395-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/01/2022] [Indexed: 11/03/2022]
Abstract
Psychoeducational groups for family members of patients with schizophrenia have proven to be effective. Borderline personality disorder (BPD) implies serious impairment in interpersonal relationships. Close relatives of individuals with BPD also show high levels of burden and need support. Psychoeducational groups could help to cope with the interactional problems in a relationship with a person with BPD. A manualised psychoeducational programme of 10 group sessions for close relatives of patients with BPD was tested. Measures administered at pretest and after 10 sessions were: perceived burden (IEQ-EU), knowledge about the disorder (WFBBPS-A) and quality of life (WHOQOL-BREF). For formative evaluation, a "Group Therapy Session Questionnaire" (participant and therapist version; GTS-A, GTS-T) was used. A total of 33 persons in three groups took part. Pre-post evaluations revealed a significantly lower level of burden and a significantly better knowledge about the disorder after participating in the psychoeducational group. Reduction of burden correlated significantly with the assessment of patients' symptom severity and carers' level of burden at study entry. There was no change in the quality of life. The participants and therapists generally rated the psychoeducational sessions very positively. The highest ratings were found in the sessions about communication skills and coping with crises. Findings indicate that the psychoeducational programme is well accepted and supportive for persons with close relationships to patients with BPD.
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Hansen NH, Bjerrekær L, Pallesen KJ, Juul L, Fjorback LO. The effect of mental health interventions on psychological distress for informal caregivers of people with mental illness: A systematic review and meta-analysis. Front Psychiatry 2022; 13:949066. [PMID: 36276315 PMCID: PMC9583525 DOI: 10.3389/fpsyt.2022.949066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/25/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Informal caregivers of people with a mental illness are at increased risk of developing depression, anxiety, and stress, so preventive interventions are needed. METHOD The review was reported in PROSPERO (ID: CRD42018094454). The PsycINFO, PubMed, and Scopus databases were searched in June 2019. The Cochrane Risk of Bias and Jadad scale scores were used to assess study quality. Inclusion criteria were: RCTs of informal caregiver interventions regardless of the care receiver's mental illness and intervention modality. Interventions should be compared to a waitlist, treatment as usual or active control, taught in real-time by a mental health professional, include an outcome measure on psychological distress, and published in a peer-reviewed journal article in English. RCTs were excluded if the intervention was given in dyads (caregiver + care receiver), limited to the provision of respite care where the patient sample included a mix of both physical and psychological illnesses, unpublished, not peer-reviewed, study protocols, or dissertations. RESULTS A total of 2,148 studies were identified; of these, 44 RCT studies met the inclusion criteria, and 31 had sufficient data to conduct a meta-analysis including subgroup analysis (N = 1,899). The systematic review showed that thirty-one out of the 44 RCTs had an effect of the intervention on decreasing psychological distress. The results of the meta-analysis, which included informal caregiver interventions, compared to waitlist, treatment as usual, or active control, regardless of care-receiver mental illness or intervention modality showed a small effect of -0.32 (95% CI -0.53 to -0.11). The heterogeneity of the included studies was high (I 2 = 78). The subgroup analysis included manualized interventions lasting at least 8 weeks and the subgroup analysis that included an active control showed a small effect and low heterogeneity. Lack of active control and long-term follow-up is a limitation of most of the studies. CONCLUSION The evidence supports that several interventions improve the mental health of caregivers. Manualized interventions ≥ 8 weeks with active participation are most effective. Future RCTs should improve methodology, and research should investigate which intervention modality is most effective for what kind of caregiver. Future research should clearly specify what the included intervention components are, use longer follow-up times, and conduct mediational analyses to better understand what mechanisms create the effect of an intervention. SYSTEMATIC REVIEW REGISTRATION Identifier: CRD42018094454.
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Affiliation(s)
- Nanja Holland Hansen
- Department of Clinical Medicine, Danish Center for Mindfulness, University of Aarhus, Aarhus, Denmark
| | - Lasse Bjerrekær
- Department of Clinical Medicine, Danish Center for Mindfulness, University of Aarhus, Aarhus, Denmark
| | - Karen Johanne Pallesen
- Department of Clinical Medicine, Danish Center for Mindfulness, University of Aarhus, Aarhus, Denmark
| | - Lise Juul
- Department of Clinical Medicine, Danish Center for Mindfulness, University of Aarhus, Aarhus, Denmark
| | - Lone Overby Fjorback
- Department of Clinical Medicine, Danish Center for Mindfulness, University of Aarhus, Aarhus, Denmark
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Rabelo JL, Cruz BF, Ferreira JDR, Viana BDM, Barbosa IG. Psychoeducation in bipolar disorder: A systematic review. World J Psychiatry 2021; 11:1407-1424. [PMID: 35070785 PMCID: PMC8717031 DOI: 10.5498/wjp.v11.i12.1407] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/11/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a severe psychiatric disorder characterized by mood swings. Psychosocial interventions, such as psychoeducation, play an essential role in promoting social rehabilitation and improving pharmacological treatment.
AIM To investigate the role of psychoeducation in BD.
METHODS A systematic review of original studies regarding psychoeducation interventions in patients with BD and their relatives was developed. A systematic literature search was performed using the Medline, Scopus, and Lilacs databases. No review articles or qualitative studies were included in the analysis. There were no date restriction criteria, and studies published up to April 2021 were included.
RESULTS A total of forty-seven studies were selected for this review. Thirty-eight studies included patients, and nine included family members. Psychoeducation of patients and family members was associated with a lower number of new mood episodes and a reduction in number and length of stay of hospitalizations. Psychoeducational interventions with patients are associated with improved adherence to drug treatment. The strategies studied in patients and family members do not interfere with the severity of symptoms of mania or depression or with the patient's quality of life or functionality. Psychoeducational interventions with family members do not alter patients' adherence to pharmacotherapy.
CONCLUSION Psychoeducation as an adjunct strategy to pharmacotherapy in the treatment of BD leads to a reduction in the frequency of new mood episodes, length of hospital stay and adherence to drug therapy.
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Affiliation(s)
- Juliana Lemos Rabelo
- Interdisciplinary Laboratory of Medical Investigation–School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Programa de Extensão em Psiquiatria e Psicologia de Idosos, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Breno Fiuza Cruz
- Interdisciplinary Laboratory of Medical Investigation–School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Programa de Extensão em Psiquiatria e Psicologia de Idosos, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Department of Mental Health, School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | | | - Bernardo de Mattos Viana
- Programa de Extensão em Psiquiatria e Psicologia de Idosos, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Department of Mental Health, School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Izabela Guimarães Barbosa
- Interdisciplinary Laboratory of Medical Investigation–School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Programa de Extensão em Psiquiatria e Psicologia de Idosos, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
- Department of Mental Health, School of Medicine, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
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13
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Corey KL, McCurry MK, Sethares KA, Bourbonniere M, Hirschman KB, Meghani SH. Predictors of psychological distress and sleep quality in former family caregivers of people with dementia. Aging Ment Health 2020; 24:233-241. [PMID: 30588830 PMCID: PMC6663657 DOI: 10.1080/13607863.2018.1531375] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/01/2018] [Accepted: 09/29/2018] [Indexed: 10/27/2022]
Abstract
Objectives: The stress-related psychological symptoms experienced by informal family caregivers do not always improve or resolve after the death of the care recipient. The purpose of this study was to explore the independent associations of sociodemographic variables, personality and coping, environmental variables, and caregiver guilt with the sleep quality and psychological distress of former family caregivers of individuals with dementia following care recipient's death.Method: A cross-sectional, correlational study was conducted with a sample of 171 former family caregivers of people with dementia. Participants completed an online survey comprised of six instruments and demographic items. Caregiver personal variables (e.g. personality and coping), environmental variables, guilt, psychological distress (depressive and anxiety symptoms), and sleep quality were evaluated using psychometrically validated measures.Results: In bivariate analysis, post-caregiving guilt was significantly associated with depressive and anxiety symptoms (p < 0.01). After controlling for covariates, dysfunctional coping and neuroticism explained 32% of the variance in depressive symptoms (R2 = .52, ΔR2 = .32, F(5, 165) = 36.24, p < .001) and 24% of the variance in anxiety symptoms (R2 = .41, ΔR2 = .24, F(5, 165) = 22.65, p < .001), while dysfunctional coping, pre-loss depression, and extraversion accounted for 16% of the variance in sleep quality (R2 = .30, ΔR2 = .16, F(6, 164) = 11.44, p < .001).Conclusion: This study demonstrates the critical role of personal variables, including personality traits, coping strategies, and pre-loss depression, in explaining psychological distress and sleep quality in this sample of former dementia caregivers.
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Affiliation(s)
- Kristin L. Corey
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Mary K. McCurry
- Department of Adult Nursing, University of Massachusetts Dartmouth, Dartmouth, MA, United States
| | - Kristen A. Sethares
- Department of Adult Nursing, University of Massachusetts Dartmouth, Dartmouth, MA, United States
| | - Meg Bourbonniere
- College of Nursing, University of Rhode Island, Kingston, RI, United States
| | - Karen B. Hirschman
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Salimah H. Meghani
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
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14
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McEvoy PM, Targowski K, McGrath D, Carter O, Fursland A, Fitzgerald M, Raykos B. Efficacy of a brief group intervention for carers of individuals with eating disorders: A randomized control trial. Int J Eat Disord 2019; 52:987-995. [PMID: 31199017 DOI: 10.1002/eat.23121] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Interventions for carers of individuals with eating disorders are often time and resource intensive, which may be a barrier for service providers or attendees. This study aimed to evaluate the efficacy of a very brief, two-session psychoeducation and communication skills-based intervention for carers of individuals with eating disorders. METHOD Carers (N = 44) were randomized to attend two 2.5 hr sessions delivered 1 week apart or waitlist control. Carer burden, self-efficacy, skills, knowledge, expressed emotion (emotional overinvolvement and critical comments), distress (anxiety and depression), and accommodating and enabling behaviors were assessed at preintervention and postintervention and 1-month follow-up. RESULTS Carer burden, self-efficacy, skills, knowledge, and one component of expressed emotion (critical comments) improved significantly more in the treatment group compared to the waitlist. Changes in anxiety, depression, and accommodating and enabling behaviors did not significantly differ between groups. DISCUSSION These results demonstrated that substantial improvements can be made from a very brief carers' intervention. More intensive and targeted interventions might be required to address carers' emotional symptoms and to reduce accommodating and enabling behaviors.
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Affiliation(s)
- Peter M McEvoy
- School of Psychology, Curtin University, Perth, Western Australia, Australia.,Department of Health, Centre for Clinical Interventions, Perth, Western Australia, Australia
| | - Katharina Targowski
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Diana McGrath
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Olivia Carter
- Department of Health, Centre for Clinical Interventions, Perth, Western Australia, Australia
| | - Anthea Fursland
- Department of Health, Centre for Clinical Interventions, Perth, Western Australia, Australia.,Western Australia Eating Disorders Outreach & Consultation Service, Perth, Western Australia, Australia
| | - Marilyn Fitzgerald
- Department of Health, Centre for Clinical Interventions, Perth, Western Australia, Australia
| | - Bronwyn Raykos
- Department of Health, Centre for Clinical Interventions, Perth, Western Australia, Australia
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15
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Yang Y, Fletcher K, Whitehead R, Murray G. Toward New Therapeutic Mechanisms in Bipolar Disorder: Analog Investigation of Self-Compassion and Nonattachment to Self. Front Psychol 2018; 9:1848. [PMID: 30319518 PMCID: PMC6171443 DOI: 10.3389/fpsyg.2018.01848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 09/10/2018] [Indexed: 12/05/2022] Open
Abstract
There is growing interest in psychological processes that might be targeted in treatments for bipolar disorder (BD). One such process is a vulnerability at the level of self-concept, characterized by presence of, and fluctuations between positive and negative self-concept. The aim of the present study was to advance this literature by investigating the role of two emerging meta-cognitive processes – self-compassion and nonattachment to self – which have potential to therapeutically modulate this unstable self-concept in BD. Using an analog design, it was hypothesized that both variables would mediate the relationship between bipolar tendencies and psychological distress in a general population sample. Participants (N = 372 Australian university students) completed self-report measures of manic and depressive tendencies, self-compassion, nonattachment to self and psychological distress. To investigate the specificity of the two hypothesized mediators, a better-researched psychological variable – rumination – was also included in mediation analyses. Bivariate analyses found tendencies toward mania and depression to be associated with diminished self-compassion and nonattachment to self, while both psychological processes were negatively associated with psychological distress. Mediation analyses showed, as expected, self-compassion and nonattachment to self mediated the relationship between bipolar tendencies and psychological distress after controlling for the effects of rumination. The present findings add incrementally to this literature by demonstrating that two meta-cognitive processes – self-compassion and nonattachment to self – act as mediators, and may be modifiable mechanisms linking bipolar vulnerability to negative mood outcomes. Future research should tackle longstanding conceptual issues in this domain, including the relationship between contents of self-concept (an established focus of BD research) and the person’s meta-cognitive approach to their self-concept (the focus here).
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Affiliation(s)
- Yan Yang
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Kathryn Fletcher
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Richard Whitehead
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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16
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Baruch E, Pistrang N, Barker C. Psychological interventions for caregivers of people with bipolar disorder: A systematic review and meta-analysis. J Affect Disord 2018; 236:187-198. [PMID: 29747136 DOI: 10.1016/j.jad.2018.04.077] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/10/2018] [Accepted: 04/14/2018] [Indexed: 01/28/2023]
Abstract
AIMS Clinical guidelines recommend that psychological interventions be offered to caregivers of people with bipolar disorder. However, there is little clarity about the efficacy of such interventions. This review examined the efficacy of psychological interventions in improving caregiver-focused outcomes, including burden, psychological symptoms and knowledge. METHOD A systematic search for controlled trials was conducted using a combination of electronic database searches (PsycINFO, MEDLINE, and CENTRAL), and hand searches. Risk of bias was assessed using the Cochrane Collaboration tool. Outcomes were meta-analysed using Review Manager (RevMan). RESULTS Nine studies met inclusion criteria. All meta-analyses compared psychoeducation to a control. At post-treatment there was a large effect of psychoeducation on burden (g = -0.8, 95% CI: -1.32, -0.27). However, there was high heterogeneity, confidence intervals were wide, and the effect was not maintained at follow-up. The apparent effect of psychoeducation on psychological symptoms was driven by a single outlying study. There was a very large effect on knowledge at post-treatment (g = 2.60, 95% CI: 1.39, 3.82) and follow-up (g = 2.41, 95% CI: 0.85, 3.98). LIMITATIONS There was considerable diversity in study methodology and quality. The number of included studies and sample sizes were small. CONCLUSIONS This review provides tentative meta-analytic evidence for the efficacy of psychoeducation in improving caregiver burden at post-treatment, and knowledge at post-treatment and follow-up. Services could consider offering psychoeducation as part of a multi-disciplinary package of care. However, more methodologically rigorous research is needed before clinical recommendations can be made with confidence.
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Affiliation(s)
- Ella Baruch
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
| | - Nancy Pistrang
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Chris Barker
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
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17
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Pakpour AH, Modabbernia A, Lin CY, Saffari M, Ahmadzad Asl M, Webb TL. Promoting medication adherence among patients with bipolar disorder: a multicenter randomized controlled trial of a multifaceted intervention. Psychol Med 2017; 47:2528-2539. [PMID: 28446253 DOI: 10.1017/s003329171700109x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The present research aimed to investigate the efficacy of a multifaceted intervention that included motivational interviewing (MI) and psychoeducation in improving medication adherence (MA) among patients with bipolar disorder (BD). METHOD A multicenter, cluster randomized, observer-blind, controlled, parallel-group trial was conducted in ten academic centers in Iran. Patients with BD were randomly assigned to the experimental group (EXP; n = 136) or the usual care group (UC; n = 134). The EXP group received five sessions of MI and psychoeducation together with their family members. The primary outcome measure was changes in scores on the Medication Adherence Rating Scale from baseline to 6 months post-intervention. Other outcome measures included serum levels of mood stabilizers, clinical symptoms, quality of life, as well as measures of intention, beliefs about medicine, perceived behavioral control, automaticity, action and coping planning, and adverse reactions. RESULTS Medication adherence improved over time in both groups, but patients in the EXP group improved more (baseline score: 6.03; score at the sixth month: 9.55) than patients in the UC group (baseline score: 6.17; score at the sixth month: 6.67). In addition, patients in the EXP group showed greater improvement than patients in the UC group in almost all secondary outcomes 6 months following the intervention. CONCLUSIONS Multifaceted interventions that include motivational-interviewing and psychoeducation can significantly improve MA and clinical and functional outcomes in patients with BD. TRIAL REGISTRATION NUMBER The trial was registered with theClinicalTrials.gov database (NCT02241863) https://clinicaltrials.gov/ct2/show/NCT02241863.
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Affiliation(s)
- A H Pakpour
- Social Determinants of Health Research Center,Qazvin University of Medical Sciences,Qazvin,Iran
| | - A Modabbernia
- Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York, NY,USA
| | - C-Y Lin
- Department of Rehabilitation Sciences, Faculty of Health & Social Sciences,The Hong Kong Polytechnic University,Hung Hom,Hong Kong
| | - M Saffari
- Health Research Center, Baqiyatallah University of Medical Sciences,Tehran,Iran
| | - M Ahmadzad Asl
- Mental Health Research Center,School of Medicine,Department of Psychiatry,Iran University of Medical Sciences,Tehran,IR Iran
| | - T L Webb
- Department of Psychology,The University of Sheffield,Sheffield,UK
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18
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Winter L, Moriarty HJ. Quality of relationship between veterans with traumatic brain injury and their family members. Brain Inj 2017; 31:493-501. [PMID: 28340316 DOI: 10.1080/02699052.2017.1283534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The quality of the relationship between patients with many illnesses and their family members has been shown to affect the well-being of both. Yet, relationship quality has not been studied in traumatic brain injury (TBI), and giving and receiving aspects have not been distinguished. The present study of veterans with TBI examined associations between relationship quality and caregiver burden, satisfaction with caregiving, and veterans' competence in interpersonal functioning, rated by veterans and family members. METHOD In this cross-sectional study, 83 veterans and their family members were interviewed at home. Measures of quality of relationship, veterans' interpersonal competence and sociodemographics were collected for both, caregiver burden and satisfaction for family members only. RESULTS As predicted, veteran-rated Qrel/Giving was associated with family-rated Qrel/Receiving, and veteran-rated Qrel/Receiving with family-rated Qrel/Giving. Lower caregiver burden and higher caregiving satisfaction were associated with higher Qrel/Receiving scores but not with Qrel/Giving scores. Veterans' interpersonal competence was associated with total Qrel as rated by either veterans or family members. CONCLUSIONS Relationship quality should be included in family research in TBI, and giving and receiving aspects should be differentiated. Findings suggest that lower caregiver burden and greater satisfaction should be more achievable by increasing caregivers' sense of benefits received from the relationship.
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Affiliation(s)
- Laraine Winter
- a Nursing Service, Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia , PA , USA.,b Philadelphia Research and Education Foundation, Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia , PA , USA
| | - Helene J Moriarty
- a Nursing Service, Corporal Michael J. Crescenz Veterans Affairs Medical Center , Philadelphia , PA , USA.,c Villanova University, College of Nursing , Villanova , PA , USA
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